Diagnostic value of neutrophil-to-lymphocyte ratio and albumin-to-globulin ratio for periprosthetic joint infections: a systematic review and meta-analysis

• Purpose: Periprosthetic joint infection (PJI) is a serious complication after joint arthroplasty, resulting in high morbidity and mortality. The neutrophil-to-lymphocyte ratio (NLR) and albumin-to-globulin ratio (AGR) are novel diagnostic markers for PJI; however, their diagnostic value remains inconsistent. • Methods: This meta-analysis was conducted using the PubMed, Embase, and MEDLINE databases to determine the diagnostic accuracy of NLR and AGR for PJI in the knee or hip. Data extraction and quality assessment were independently completed by two reviewers. The pooled sensitivity and specificity, diagnostic odds ratio (DOR), summary receiver operating characteristic curve (sROC), and area under the sROC curve (AUC) were assessed using the univariate meta-analysis framework. • Results: Nineteen eligible studies were included in the quantitative analysis. The pooled sensitivity and specificity of NLR for the diagnosis of PJI were 0.73 (95% CI: 0.68–0.77) and 0.72 (95% CI: 0.66–0.77), respectively. Its pooled DOR was 6.89 (95% CI: 5.03–9.43), and AUC was 0.79 (95% CI: 0.75–0.82). The pooled sensitivity and specificity of AGR for the diagnosis of PJI were 0.80 (95% CI: 0.70–0.88) and 0.83 (95% CI: 0.79–0.87), respectively. Its DOR was 17.69 (95% CI: 10.76–29.07), and AUC was 0.88 (95% CI: 0.85–0.91). • Conclusion: NLR and AGR can be individually used as reliable serum biomarkers for the detection of PJI. Future research is warranted to determine the diagnostic value of these markers in combination with C-reactive protein levels and erythrocyte sedimentation rates to improve diagnostic accuracy for PJI in clinical practice.